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During puberty, surprising cracks and unexpected squeaks can signal changes in your voice. Later on, as you age, you may notice other changes, such as weakening of the voice.

What’s behind these vocal shifts, and what do they say about your health?

“Lack of a voice change in boys who grow up can signal a problem,” says Voice Center Director Claudio Milstein, PhD. “Weakening of the voice later in life may point to health issues as well.”

So it makes sense to listen to your changing voice and report any concerns to your doctor.

Your voice during puberty

Puberty is a process of sexual maturation. A voice change is one of the secondary sexual characteristics adolescents develop. In boys, this happens between ages 12 and 16; in girls, between ages 10 and 14.

The first sign of puberty in girls is breast development, while in boys it’s an increase in the size of the testicles. As this is happening, the voice also changes.

“Before puberty, your larynx, or voice box, sits higher in the neck. As you go through these changes, it gets bigger and moves down lower,” explains Dr. Milstein. “Your vocal folds (cords) also thicken and enlarge.”

This change is more noticeable in boys. “They develop the typical jumping pitch, which can suddenly drop about an octave lower,” he says.

Girls’ voices also change as they mature, but less dramatically. Their pitch drops only about three tones, notes Dr. Milstein.

This process may take up to a year. Usually, by age 17, the voice fully stabilizes. If a teen’s voice hasn’t changed by that time and other secondary sexual characteristics have not developed, hormonal issues may be at play.

“Check with your child’s pediatrician if there is no change in voice, no growth, no lowering of the testicles in boys, no breast development in girls and no development of body hair,” says Dr. Milstein.

Your voice later in life

Unlike puberty, when everyone’s voice changes, voice changes with aging are not universal, Dr. Milstein says. There are two main reasons why your voice may change with age:

An aging voice box. The most common cause of a voice change later in life is aging of the voice box and the respiratory system that powers the voice.

Aging may bring a loss of flexibility. The joints of the larynx may thin, and its cartilage may calcify further. The vocal cords may lose flexibility and elasticity, and dry out. Sometimes, the muscles of the larynx can atrophy, become thinner and weaker. Your ribs may become more calcified. Your torso may shrink, and your lungs may become smaller, stiffer and less pliable.

All of these changes may weaken the voice, Dr. Milstein says.

A decline in overall health status. Sometimes, a voice change can herald a developing medical problem. For example, chronic fatigue and neurological problems can cause a shaking, or tremor, in the voice. The voice can also change if cancer, a polyp or paralysis affect your vocal cords.

Rejuvenating the voice

A diminishing voice sometimes leads to a less active social life, Dr. Milstein says. “If it’s difficult for others to hear and understand you, you may not want to sing in church, volunteer, or go out with friends,” he says. “When you become more socially isolated, your quality of life drops. This can lead to depression and affect overall health.”

But that doesn’t have to happen. If you’re having voice issues, it’s wise to be evaluated by a voice specialist, a laryngologist, or a speech pathologist with expertise in voice.

“We’ll examine your vocal cords to determine the problem,” he says. “Thanks to modern science and technology, many treatments can make your voice sound better.” These include:

Voice therapy: Daily voice exercises to strengthen voice production.

Vocal cord microsurgery: A treatment for vocal cord lesions, such as polyps or cysts.

Voice injections: Injections to plump up the vocal cords.

Voice implants: Implants to stabilize the vocal cords.

“Once we rejuvenate the voice, communication and quality of life improve. We find that patients socialize more and participate in more activities.